I42.9
BillableCardiomyopathy, unspecified
HCC Category Mapping
V28HCC 227 — Cardiomyopathy
0.339V24HCC 85 — Congestive Heart Failure
0.368ESRDHCC 85 — Congestive Heart Failure
0.000RxHCCHCC 186 — Heart Failure
0.000What This Code Means
A general diagnosis of heart muscle disease when the specific type or cause cannot be determined or is not documented.
Coding Tips
- •This is a non-specific code; query the provider for additional information to determine the cardiomyopathy type (dilated, hypertrophic, restrictive, etc.)
- •Use only when more specific cardiomyopathy codes cannot be applied based on available documentation
Clinical Significance
Unspecified cardiomyopathy indicates heart muscle disease without documented type or etiology. While this captures the presence of cardiomyopathy for risk adjustment, the lack of specificity limits clinical utility and may raise audit concerns. Provider queries should be pursued to determine the specific type.
Documentation Requirements
- ✓Provider diagnosis of cardiomyopathy
- ✓Evidence that more specific classification cannot be determined
- ✓Echocardiographic or other imaging evidence of cardiac dysfunction
- ✓Symptoms and functional limitations documented
- ✓Documentation of any workup performed to determine the type
Commonly Confused Codes
I42.0 — Dilated cardiomyopathy; most common type, often the actual diagnosisI42.1 — Obstructive hypertrophic cardiomyopathy; thickened with obstructionI42.8 — Other cardiomyopathies; use when a specific type is documented but not otherwise classifiedI50.9 — Heart failure, unspecified; a consequence of cardiomyopathy, not the same diagnosis